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1 – 10 of 247Konstantinos Dinas, Eleftherios Vavoulidis, Georgios Chrysostomos Pratilas, Kimon Chatzistamatiou, Alexandros Basonidis, Alexandros Sotiriadis, Leonidas Zepiridis, Konstantinos Pantazis, Konstantinos Tziomalos, Vassilis Aletras and George Tsiotras
The purpose of this paper is to investigate the attitudes of healthcare professionals in Greece toward safety practices in gynecological Operation Rooms (ORs).
Abstract
Purpose
The purpose of this paper is to investigate the attitudes of healthcare professionals in Greece toward safety practices in gynecological Operation Rooms (ORs).
Design/methodology/approach
An anonymous self-administered questionnaire was distributed to surgical personnel asking for opinions on safety practices during vaginal deliveries (VDs) and gynecological operations (e.g. sponge/suture counting, counting documentation, etc.). The study took place in Hippokration Hospital of Thessaloniki including 227 participants. The team assessed and statistically analyzed the questionnaires.
Findings
Attitude toward surgical counts and counting documentation, awareness of existence and/or implementation in their workplace of other surgical safety objectives (e.g. WHO safety control list) was assessed. In total, 85.2 percent considered that surgical counting after VDs is essential and 84.9 percent admitted doing so, while far less reported counting documentation as a common practice in their workplace and admitted doing so themselves (50.5/63.3 percent). Furthermore, while 86.5 percent considered a documented protocol as necessary, only 53.9 percent admitted its implementation in their workplace. Remarkably, 53.1 percent were unaware of the WHO safety control list for gynecological surgeries.
Originality/value
Most Greek healthcare professionals are well aware of the significance of surgical counting and counting documentation in gynecology ORs. However, specific tasks and assignments are unclear to them. Greek healthcare professionals consider surgical safety measures as important but there is a critical gap in knowledge when it comes to responsibilities and standardized processes during implementation. More effective implementation and increased personnel awareness of the surgical safety protocols and international guidelines are necessary for enhanced quality of surgical safety in Greece.
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Markus Orava and Malin Brännback
This paper describes a modelling process the objective of which was to make the highly abstract concept of core competence practical. The aim is to identify competences through…
Abstract
This paper describes a modelling process the objective of which was to make the highly abstract concept of core competence practical. The aim is to identify competences through the use of a service-process model by analyzing what they reflect – the service quality. Core competence is defined, and a conceptual model is presented. Competences are classified on three levels in a corporate setting and the connections drawn to service quality. Empirical evidence is provided by a case in the health-care sector in which competences are identified through the use of the service-process model in high-performance, professional services. The service-process model in surgical medical services is presented. Critical elements in the service-quality experience are identified and core competences are identified based on service quality as a reflection of them and their management.
Robert Shapiro, Rose Laignel, Caitlin Kowcheck, Valerie White and Mahreen Hashmi
Previous studies indicate adherence to pre-operative antibiotic prophylaxis guidelines has been inadequate. The purpose of this paper is to determine adherence rates to current…
Abstract
Purpose
Previous studies indicate adherence to pre-operative antibiotic prophylaxis guidelines has been inadequate. The purpose of this paper is to determine adherence rates to current perioperative antibiotic prophylaxis guidelines in gynecologic surgery at a tertiary care, academic institution. As a secondary outcome, improving guidelines after physician re-education were analyzed.
Design/methodology/approach
A retrospective chart review (2,463 patients) was completed. The authors determined if patients received perioperative antibiotic prophylaxis in accordance with current guidelines from the America College of Obstetricians and Gynecologists. Data were obtained before and after physician tutorials. Quality control was implemented by making guideline failures transparent. Statistical analysis used Fisher’s exact and agreement tests.
Findings
In total, 23 percent of patients received antibiotics not indicated across all procedures. This decreased to 9 percent after physician re-education and outcome transparency (p<0.0001). Laparoscopy was the procedure with the lowest guideline compliance prior to education. The compliance improved from 52 to 92 percent (p<0.0001) after re-education.
Practical implications
Gynecologic surgeons overuse antibiotics for surgical prophylaxis. Physician re-education and transparency were shown to enhance compliance.
Originality/value
Educational tutorials are an effective strategy for encouraging physicians to improve outcomes, which, in turn, allows the healthcare system a non-punitive way to monitor quality and mitigate cost.
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Sarah Westbury, Meghana Pandit and Jaideep J. Pandit
This paper sets out to investigate whether demand for gynaecological theatre time could be described in terms of the time required to undertake elective operations booked for…
Abstract
Purpose
This paper sets out to investigate whether demand for gynaecological theatre time could be described in terms of the time required to undertake elective operations booked for surgery, and so help match the capacity to this.
Design/methodology/approach
A questionnaire assessed the estimates for total operation time for seven common operations, sent to surgeons, anaesthetists and nursing staff in one tertiary referral and one district general hospital (total 49 staff; response rate 58 per cent), and estimates were obtained from theatre computer logs. Average timings for each operation were then applied to cases added from clinics to the waiting list at the district general, to yield the mean demand for elective surgery, and were also applied to emergencies to estimate emergency workload. Finally these demand estimates were compared with the theatre capacity available.
Findings
The paper found no difference between the estimates of the three staff groups or between these and the theatre logs (p=0.669), nor did it find that estimates differed between the two centers (p=0.628). Including emergencies, the mean (95 per cent confidence intervals) demand at the district general was 2,438 (1,952‐2,924) min/week.
Research limitations/implications
Although the paper modelled the variation in demand using the relevant variation in operation times, any additional variation caused by differences in booking rates from clinics over time was not nodelled. The minimum period over which data should be collected was not established.
Practical implications
The paper finds that the existing capacity of 1,680 min/week did not match these needs and, unless it was increased, a rise in waiting lists was predictable.
Originality/value
The paper concludes that time estimates for scheduled operations can be better used to assess the need for surgical operating capacity than current measures of demand or capacity.
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Nick Payne, Chris Knight and Cynthia Marvin
In 1989, Trent Regional Health Authority set up a Commission toenquire into the organization of day case surgery and encourage its use.Improved methods for measuring and comparing…
Abstract
In 1989, Trent Regional Health Authority set up a Commission to enquire into the organization of day case surgery and encourage its use. Improved methods for measuring and comparing day surgical activity were developed using routine data sources. These revealed even greater variation between hospitals and specialties in the amount of day surgery performed than did the usual analyses. Arrangements for day surgery differed considerably between specialties. Few theatres, beds, or surgeons′ sessions were dedicated to day surgery, but general surgery and gynaecology used dedicated facilities more than other specialties such as ENT and ophthalmology. The Commission visited each hospital and found that day case facilities, organization and resources were poor in many of them. It was able to make specific recommendations for improvements. Day case surgery increased substantially over the period that the Commission operated, most hospitals reported that it had influenced changes in day surgery and that it had been useful, especially for local managers. Schemes to increase day surgery were funded. Highlights two elements for managing change: the need for good information about a problem, and the need to extend ownership of the issue throughout the organization.
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With an aim to investigate the recent state of the feminist clinics and their negotiation of medical authority in a time of increased technoscientific biomedicalization, and…
Abstract
With an aim to investigate the recent state of the feminist clinics and their negotiation of medical authority in a time of increased technoscientific biomedicalization, and capitalistic health-care system, I conducted a study of two feminist health centers in the Northeast of the United States in 2001–2002. In this chapter, I discuss how the two centers (a nonprofit collective and a for-profit center with a more hierarchical structure) negotiated medical authority in organizational terms as impacted by the larger context of medicine and its interaction with the state, capitalist health-care system, and antiabortion forces. The chapter concludes with a discussion of demedicalization as a multilevel process and implications for feminist care (service delivery) and U.S. Women's Health Movement.
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The purpose of this paper is to present a three-part framework of information engagement for situated gynecological cancers. These particular cancers intertwine with…
Abstract
Purpose
The purpose of this paper is to present a three-part framework of information engagement for situated gynecological cancers. These particular cancers intertwine with medicalization of sexuality and gender power dynamics, situating information behaviors and interactions in women’s socio-health perceptions. Using Kavanagh and Broom’s feminist risk framework, the framework establishes functional and temporal parameters for sense-making and information engagement.
Design/methodology/approach
This paper employs a structured, reiterative literature review with emergent thematic analysis. Nine indices from medicine, information studies, and sociology were searched using combinations of five terms on cervical cancer (CC) and 14 terms on information engagement in the title, abstract, and subject fields. Results were examined on a reiterative basis to identify emergent themes pertaining to knowledge development and information interactions.
Findings
Environmentally, social stigma and gender roles inhibit information seeking; normalizing CC helps integrate medical, moral, and sexual information. Internally, living with the dichotomy between “having” a body and “being” a body requires high-trust information resources that are presented gradually. Actively, choosing to make or cede medical decision-making requires personally relevant information delivered in the form of concrete facts and explanations.
Research limitations/implications
The study covers only one country.
Originality/value
This study’s information framework and suggestions for future research encourage consideration of gender power dynamics, medicalization of sexuality, and autonomy in women’s health information interactions.
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Sara Candidori, Serena Graziosi, Paola Russo, Kasra Osouli, Francesco De Gaetano, Alberto Antonio Zanini and Maria Laura Costantino
The purpose of this study is to describe the design and validation of a three-dimensional (3D)-printed phantom of a uterus to support the development of uterine balloon tamponade…
Abstract
Purpose
The purpose of this study is to describe the design and validation of a three-dimensional (3D)-printed phantom of a uterus to support the development of uterine balloon tamponade devices conceived to stop post-partum haemorrhages (PPHs).
Design/methodology/approach
The phantom 3D model is generated by analysing the main requirements for validating uterine balloon tamponade devices. A modular approach is implemented to guarantee that the phantom allows testing these devices under multiple working conditions. Once finalised the design, the phantom effectiveness is validated experimentally.
Findings
The modular phantom allows performing the required measurements for testing the performance of devices designed to stop PPH.
Social implications
PPH is the leading obstetric cause of maternal death worldwide, mainly in low- and middle-income countries. The proposed phantom could speed up and optimise the design and validation of devices for PPH treatment, reducing the maternal mortality ratio.
Originality/value
To the best of the authors’ knowledge, the 3D-printed phantom represents the first example of a modular, flexible and transparent uterus model. It can be used to validate and perform usability tests of medical devices.
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Susan Griffin, Leigh McGrath, Gregory T. Chesnut, Nicole Benfante, Melissa Assel, Aaron Ostrovsky, Marcia Levine, Andrew Vickers, Brett Simon and Vincent Laudone
The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative…
Abstract
Purpose
The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes.
Design/methodology/approach
This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates.
Findings
Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified.
Originality/value
This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.
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The purpose of this paper is to review the progress that one innovative firm is making in the development and deployment of robots to actually perform surgery on humans with a…
Abstract
Purpose
The purpose of this paper is to review the progress that one innovative firm is making in the development and deployment of robots to actually perform surgery on humans with a doctor's guidance.
Design/methodology/approach
Detailed dialog with the development team for the da Vinci® Surgical System at Intuitive Surgical and with several medical institutions that have deployed the system.
Findings
The success of applying robotic technology to surgery only confirms that human activity and automation are ever closer bound together. The robot provides surgical advantages such as improved visualization, precision of movement, range of movement, ergonomics, and dexterity, and often times better procedure outcomes.
Practical implications
Medical technology can be improved by the linking surgeons with robotics. Surgery joins other once thought of as human only activities, such as reading books, filling orders, etc. which can be improved with robotics.
Originality/value
Other hospitals may find the innovation and success of robotic surgery to be of value to their medical services menu.